A federal task force that gave prostate cancer screening a D grade -- as in don't screen men who have no symptoms of the disease -- should bump that rating to a C, an MD Anderson scientist argues this week in a commentary in the Journal of the American Medical Association.

A grade C more closely fits available clinical evidence and will encourage clinicians to engage men in informed decision-making, a process that the D grade is likely to preempt, Robert Volk, Ph.D., professor in General Internal Medicine, notes with co-author Andrew Wolf, M.D., of the University of Virginia.

The USPSTF reviews evidence from clinical research and then recommends a variety of grades for a service, ranging from A (recommended, with a high certainty that the net benefit is substantial) to D (recommends against the service because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.)

Prostate cancer screening by testing for levels of the prostate-specific antigen currently has an I grade -- the current evidence is insufficient to assess the balance of benefits and harms of the service.

Based on trial results
Volk and Wolf note that the task force relied on the results of three randomized screening trials, which it rated as being of fair quality. Two of those three show a benefit of screening.

MD Anderson researchers have identified molecular factors that erode the effectiveness of two important drugs for multiple myeloma.  For each mechanism of resistance, the scientists also pinpointed both a drug that overcame that resistance in cell line experiments and a potential biomarker that could guide combination therapy.

Lenalidomide, known as Revlimid®, and bortezomib, known as Velcade®, are usually used in combination with other drugs both in frontline therapy and for treatment of recurrent or resistant myeloma.  However, they don't work for every patient and when they are effective can lose their punch over time as the disease develops defenses against them.

There are multiple mechanisms of drug resistance, so identifying which ones are at work in a given patient and targeting them specifically is critical, said Robert Orlowski, M.D., Ph.D., professor and head of the Multiple Myeloma Section in MD Anderson's Department of Lymphoma and Myeloma.

"Science is more important than ever now in multiple myeloma, because we can't just use the same combinations to treat refractory disease," Orlowski says.

Orlowski and colleagues reported their results at the 53^rd Annual Meeting of the American Society of Hematology earlier this month.

Adding a third drug to frontline combination therapy for acute myeloid leukemia resulted in an 85% complete remission rate in a clinical trial at The University of Texas MD Anderson Cancer Center.

 

Researchers reported study results today at the 53rd Annual Meeting of the American Society of Hematology. The high overall response rate to initial treatment in the Phase II clinical trial will lead to a nationwide Phase III clinical trial of the three-drug combination.

 

The 75 patients on the study received the drug vorinostat, known commercially as Zolinza, a histone deacetylase inhibitor, in addition to the chemotherapy drug cytarabine and idarubicin, an anthracycline antibiotic commonly used as chemotherapy.

 

"The overall response rates are encouraging, and most higher risk patients did very well," says study leader Guillermo Garcia-Manero, M.D., professor in MD Anderson's Department of Leukemia. Garcia-Manero will be the principal investigator of the Phase III trial, which will be conducted through the National Cancer Institute's Cooperative Oncology Groups.

A promising new class of drugs may shift treatment of the most common form of adult leukemia from combination chemotherapies to a more customized approach.

One such B cell receptor inhibitor, called PCI-32765, continues to show improved effectiveness in an ongoing clinical trial with relatively mild side effects compared to existing treatment.

Susan O'Brien, M.D., professor in MD Anderson's Department of Leukemia, will present updated results of a Phase II clinical trial of 61 patients with relapsed or resistant CLL Tuesday at the 53rd Annual Meeting of the American Society of Hematology. She spoke about the results at a news briefing today.

The hallmarks of the drug so far are a steady increase in patients achieving either complete or partial remission over time, low toxicity and lack of myelosuppression - the inhibition of bone marrow function that causes reduced blood cell production, O'Brien says.

"When we first reported results of this trial at ASH a year ago, 25% or patients had a partial response," O'Brien says. "By the time we presented in June at the American Society of Clinical Oncology meeting, the overall response rate was 48%. Now it's approaching 70% with either complete or partial remission.

"Lack of myelosuppression is exciting, because the most important complication we face treating CLL now is infection caused by myelosuppression," O'Brien says, "and these patients have compromised immune systems already." Infections spring from suppression of white blood cell production.

Chronic lymphocytic leukemia is caused by overproduction of defective B cell lymphocytes, white blood cells that fight infection by producing antibodies.

Additional resources: 

Patient Power video interview.

ASH Abstract 983 (Click OK on the prompt from ASH to view the abstract.)

MD Anderson news release

By Naoto Ueno, M.D., Ph.D., Department of Breast Medical Oncology

Inflammatory breast cancer (IBC) is one of the most aggressive subtypes of breast cancer.  The MD Anderson Morgan Welch Inflammatory Breast Cancer Program and Clinic had a major presence at the San Antonio Breast Cancer Symposium with nearly 15 abstracts related to IBC. They included research on cytokine changes, mesenchymal stem cell interaction and several new targets.

So, what are the three most important issues in the field of IBC?

1. We need to differentiate the disease from non-IBC cancers at the molecular level, so oncologists can establish universal criteria for the diagnosis of IBC.
2. We need to find unique causes of IBC that can be developed as IBC-specific targets. 
3. We need to uncover the risk factors associated with the development of IBC.
   

To address these issues it takes team medicine (multidisciplinary care) and team science. This applies internally at MD Anderson, but it's also critical to have a collaborative project at the international level. 

By Naoto Ueno, M.D., Ph.D., Department of Breast Medical Oncology

Attending the San Antonio Breast Cancer Symposium for the past two years as a member of press is always a very pleasing and rewarding experience. As some of you may know, I'm a semi-professional blogger and very active on Twitter and Facebook.

One thing that I learned from my press activities is that the stereotype of journalists is not necessarily true. There are many talented people, who report accurately, and are often critical about conference presentations. Journalists have an important duty to ensure their messages are correct. I also think that MD Anderson's communication office does a very good job coordinating press activities. 

For successful message delivery, coordination is important to make sure the conference presenter and journalist communicate well. Not all journalists have a scientific or medical background, so it's important that conference presentations are accurate, but simple enough for a layperson to understand.

In an MD Anderson-led study presented at the San Antonio Breast Cancer Symposium today, researchers presented new data about a combination drug therapy for women with metastatic breast cancer.  

The study, known as Breast Cancer Trials of Oral Everolimus (BOLER0-2 ), found that combining everolimus, with hormonal therapy drug exemestane, resulted in a two-fold increase in progression-free survival for postmenopausal women who received prior endocrine therapy.

Everolimus inhibits the mammalian target of rapamycin (mTOR) protein, a central regulator of tumor cell division and blood vessel growth in breast cancer cells; the mTOR pathway is activated in hormone-resistant breast cancer.

Gabriel Hortobagyi, M.D., professor and chair of MD Anderson's Department of Breast Medical Oncology, says the study is "based on the concept that recognizes an increased understanding of signaling pathways and the efficacy of using a dual-attack approach to target them."